Drug Prior Authorizations

Some drugs and certain quantities of some drugs require approval before they are eligible for coverage under your pharmacy benefits. These medications are on the prior-authorization list because they have a limited place in therapy or a narrow therapeutic margin, require special monitoring or could be misused or abused. For prior authorization approval, a doctor needs to provide clinical information to HometownRx to be reviewed by our Clinical Pharmacist for medical necessity and appropriateness of therapy.

Who can request a Prior Authorization?

Providers

We encourage providers to fax in the prior authorization request forms to the fax number provided on the appropriate form.

  Download the Large and Small Group Medication Request Form (PDF)

  Download the Individual and Family Medication Request Form (PDF)

Members

Members can request prior authorization for their medications by calling our pharmacy customer support team.

Terms and Conditions

Prior authorizations can take up to 7 business days for a decision to be made.

It is up to the doctor or member to request authorization renewal to ensure there is no gap in care.

If a medication is purchased outside of the authorization approval window, the claim would not be eligible for reimbursement.